Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 5901001427 | MI |
NPI | 1275628075 |
---|---|
Provider Name | David Michael Kowal |
First Address | Flint, MI 48504-6861 |
Second Address | Flint, MI 48504-6861 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 26/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134400940 | (05) | MI |
2748413 | (05) | MI |
480033814 | (05) | MI |
480033814 | RAIL ROAD MEDICARE (01) | MI |
T92710 | (02) |